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Thread: Experientce with screenings/exams at nursing homes?

  1. #1
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    Experientce with screenings/exams at nursing homes?


    This week I met the executive dir. and administrator of a local nursing home at a golf outing. They are looking for an optometrist to come in and do exams for their residents (short and long term care). The patient insurance is a mix of Medicare, Medicaid and self pay, and most of the family members live in the immediate area. What has been others experience with going to nursing homes? Is more trouble than its worth? or, in additon to providing a valuable service, was it good for your practice. thanks for the help.

    should be "Experience with..."
    Last edited by kdog2020; 09-16-2007 at 01:14 PM.

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    Master OptiBoarder rbaker's Avatar
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    My personal feelings based upon both providing these services and having family members in nursing home/skilled care facilities are that this is akin to ambulance chasing. First of all these so called screenings or exams are best performed in an office or clinical setting. In addition, most of these visits are superfluous as the patient probably has an eyecare provider and without the consent of the patient or their health care proxy may result in a duplication of services or services that the patient does not want or need.

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    Actually, I think there are a great number of our elderly who live in nursing homes and have little to no access to eye care of any kind. Or if they do have access they seldom are able to go because of the cost involved. Any idea how much a wheelchair-accessible van is to rent to take someone to an eye doctor's office?

    The general story seems to be a new OD will do nursing home visits until the frustration level gets too high, and then give up. A lot has to do with the way the system works, or doesn't. Residents of the home usually need to have their payments handled by their children or family. This is who you often need to get permission from to buy them glasses. Medical issues need to come in the form of official doctor's orders, or often the claims will be denied.

    Doing it the right way could help a lot of people. Line everything up and have things planned out as best you can. Be a help to the staff instead of one more hassle and you will have a better chance of succeeding.

    Dealing with the elderly is a different skill than performing a "normal" exam in an office. Both can be done effectively and efficiently. If you are an optician who is hiring ODs, you need to have them enthusiastic about it. A lot of people didn't like the nursing home rotation in optometry school, from what I remember.

    The unfortunate thing in school was that despite the fact that they knew we were coming, we were bottom of the barrel in terms of importance. All too often we had miscommunications with nursing staff. Patients were out eating when they were supposed to be given an exam. We weren't told other patients were out for the day to another specialist's office. Stuff like that was all too common and could be easily fixed.

    As for screenings, imo, most are a waste of time. Better to do talks and educate than give people the feeling they just had a full exam and could wait another 10 years before seeking care. More harm than good.

    Portable slit lamp, BIO, near cards, distance card, tonopen or perkins, even a handheld autoref/ker, retinoscope, trial lenses. You can do virtually anything in there that you could do in a lane.

    financially, medicare bases some reimbursement on the fact that you have office overhead. So, in a nursing home you aren't using the office and thus they don't pay you for that portion of the reimbursement. End result is a nursing home exam is less reimbursement than an office visit, assuming you are coding at the same level and the all the other criteria were met.

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    Quote Originally Posted by rbaker View Post
    My personal feelings based upon both providing these services and having family members in nursing home/skilled care facilities are that this is akin to ambulance chasing.
    I could see this happening too easily. However, in this case it was the ED and administrator of the home asking for someone to provide the service.

    did some checking and this facility is an "intermediate and skilled care facility" and not technically a nursing home. I want to set up a meeting with the administrator to find out what the previous ODs had provided, and what would work best for the facility.

    Since expending the medical services in the our office, we see many multi-generation families who face the challenge of caring for older parents in addition to their own families. I am certainly aware of working with the facility to provide a service that helps the patient and family, not just a business opportunity.

    Orangezero--thanks for the input. My conversations with the administrator (albeit during a round of golf) did not cover anything about materials, so I do not know if the others were routinely doing glasses for the residents. I could see where that would be a problem--heck, its hard enough getting pts to pay for their own glasses in the office sometimes:D I thought the billing would change due to change in location--I'll have to check what we would get for the visit. The doc actually prefers working with older pts, so thats not a problem.

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    Master OptiBoarder rbaker's Avatar
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    Medicare and Medicaid pay for transportation to doctors offices, clinics or hospital so cost is of no issue for those without funds provided that they are medically necessary. And, does poor old granny, suffering end stage cancer really need to have her IOP's recorded. Cripes, I have seen vision screenings on hospice patients.

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    Quote Originally Posted by rbaker View Post
    Medicare and Medicaid pay for transportation to doctors offices, clinics or hospital so cost is of no issue for those without funds provided that they are medically necessary. And, does poor old granny, suffering end stage cancer really need to have her IOP's recorded. Cripes, I have seen vision screenings on hospice patients.
    I understand what you are saying. But who should be the one to decide? Medicare is a complaint driven system, so only those with problems or previous eye issues receive care.

    I know if I was living in a nursing home, I'd want to know if I would lose functional vision before my death. I'd expect my health professionals to want to stop that from happening.

    I think we are mixing screenings with examinations. Totally different.

    I'd be willing to bet that quick little trip to the local optometrist or ophthalmologist costs medicare more than the exam (and glasses) they receive at the office.

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    Quote Originally Posted by orangezero View Post
    The general story seems to be a new OD will do nursing home visits until the frustration level gets too high, and then give up. A lot has to do with the way the system works, or doesn't.
    Took the words right out of my mouth...

    There's a reason why it's so easy to break into this market. If there were any money in it, the barriers would be much higher.

    We do a few nursing homes, but it is more of a marketing/image thing, and we would definitely not do soley for the small amount of revenue it brings in. My ODs wont' do them at all, and we do only the glasses, and repairs, often not charging because it's not worth the hassle. Not to sound too corny, but the "feel good" part of it is often enough for us.

    :cheers:
    Ophthalmic Optician, Society to Advance Opticianry

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    Quote Originally Posted by rbaker View Post
    Medicare and Medicaid pay for transportation to doctors offices, clinics or hospital so cost is of no issue for those without funds provided that they are medically necessary. And, does poor old granny, suffering end stage cancer really need to have her IOP's recorded. Cripes, I have seen vision screenings on hospice patients.
    I think we get the idea. If you read the thread, this is a different situation. Thanks for your help.

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    Bad address email on file Dougfir8's Avatar
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    One office that does nursing home visits and sends our lab the order also encloses a pre-adjusted frame. We use that frame and send a new replacement. I guess the office then drops them off or mails the completed glasses and doesn't do a final fitting. Or, maybe pre-adjusting them makes the fitting go faster. I have wondered how well the adjustment lasts as the job goes through the surface room (we rarely can use FSV for people in this age group) and into mounting. These are Medicaid patients, with maybe a few Medicare thrown in.

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    [quote=orangezero;205669]I know if I was living in a nursing home, I'd want to know if I would lose functional vision before my death. quote]

    I put this one to my daughter who is a nurse in an assisted living and extended care facility. Her take, the residents who are functional just want to be able to read and watch TV, they don't want new frames or new lenses or to have someone come around and try to screen them for anything. In fact they wear each other's glasses half the time.

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